靶浓度控制输注异泊酚联合雷米芬太尼用于无痛人工流产术的临床观察

The effect of anesthesia with propofol target-controlled infusion and remifentanil in painless artificial abortion

目的:旨在通过比较不同血浆靶浓度控制输注 (TCI)异泊酚联合一定剂量雷米芬太尼 (REM)后的麻醉效能,及其对呼吸、循环功能的影响和不良反应,探讨用于无痛人工流产术的合理配伍。 方法: 100例早孕患者,均无麻醉前用药,随机分为 4组,每组 25例。Ⅰ组单纯使用 1%异泊酚,血浆靶浓度设定为 7. 5mg/L;Ⅱ、Ⅲ、Ⅳ组在输注异泊酚前 1min先静脉注射REM 0. 3μg/kg,注射时间为 30s,异泊酚血浆靶浓度分别设定为 5. 0mg/L、5. 5mg/L和 6. 0mg/L,待患者睫毛反射消失后开始操作,吸宫结束时停用异泊酚。观察术前、睫毛反射消失时、扩宫时、吸宫时和手术结束时的血压(BP)、脉搏氧饱和度 (SpO2 )、心率 (HR),诱导时间、手术时间、唤醒时间和定向力恢复时间、异泊酚的总用量、患者体动及术后宫缩痛情况。 结果:与术前比较,Ⅰ组睫毛反射消失时、扩宫时的平均动脉压(MAP)、HR显著降低(P<0. 01),吸宫时MAP、HR均显著增高 (P<0. 05),Ⅱ、Ⅲ组睫毛反射消失时、扩宫时、吸宫时MAP、HR与术前比显著降低(P<0. 01),Ⅳ组各时间点MAP、HR较术前均显著降低 (P<0. 01);Ⅰ组诱导时间明显较短(P<0. 01),唤醒时间及定向力恢复时间明显延长(P<0. 01),异泊酚总用量和术后宫缩痛发生率显著增加(P<0. 01);Ⅱ组体动发生率明显增加 (P<0. 01)

Objective:To explore the reasonable compatibility of anesthetic in painless artificial abortion by comparing the effect of different target plasma propofol concentrations combined with remifentanil on anesthesia effect, respiratory, circulatory function and side-effects. Methods:One hundred early-pregnant women were randomly divided into four groups ( without pre-anesthetic drugs ): The women in group I only accepted 1% propofol, the target plasma propofol concentration set at 7.5 mg/L; while the women in group Ⅱ,Ⅲ,Ⅳ accepted 30-second injection of Remifentanil ( 0.3 μg/kg) 1 min before intravenous propofol, the target plasma propofol concentration of these three groups set at 5.0 mg/L,5.5 mg/L,6.0 mg/L respectively. The operation began after eyelash reflex vanished, and infusion stopped at the end of the suction of cavity of uterus. BP, SpO 2, HR, induction time, operation time, awake time, orientation recovery time, the general usage of propofol, patients’ body motion and postoperative uterine contraction pain were observed. Results:Compared with pre-operation, MAP, HR of group I decreased significantly (P<0.01) at the vanishing of eyelash reflex and dilatation of cervix, whereas increased remarkablely at the suction of cavity of uterus (P<0.05); in group Ⅱ and Ⅲ, these values at the time points in the course of operation all decreased significantly (P<0.01); MAP, HR at all time points of group Ⅳ decreased significantly (P<0.01). In group I, induction time shortened remarkablely (P< 0.01),awake time and orientation recovery time prolonged significantly (P< 0.01),the whole usage dosage of propofol and the pain rate of postoperative uterine contraction increased significantly (P< 0.01).Body motion rate of group II increased significantly (P<0.01), and the rate of respiratory depression of group IV increased significantly (P<0.01). Conclusion:Target plasma propofol concentration (5.5 mg/L) combined with Remifentanil ( 0.3 μg/kg) gives more efficient anesthesia and better recovery with few complications. In the meanwhile, the rate of respiratory depression appeared low and postoperative uterine contraction pain much alleviated. Therefore, it is a safe and effective anesthetic compatibility in the painless artificial abortion.